Like ACL Prevention, ACL Rehab is just Good Training

Some Q&A from a Strength Coach working with several athletes cleared for sport but not up to par to return to get on the field………

1) Do you agree that eccentric hamstring work (i.e. 5 sec lowering on slideboard or GHR) helps prevent more injuries?

I do agree, but be careful here. 100% there is enormous value to developing strength in eccentric, isometric, and concentric tension patterns. I was very moved in reading Cal Dietz’s and Ben Peterson’s Triphasic Training in understanding why a concerted focus on each of these patterns has neurological value for any cause in strength development.

However…………………………………….

People don’t really think the hamstrings “pull back” on an ACL-deficient knee, do they?

The notion that we need “hamstrings” because they posteriorly translate the tibia, and a torn ACL allows anterior translation is total nonsense. That is typical commercial PT stuff that was old in 1985.
Movements that appear to focus more on the hamstrings are great special exercises that can bring up a weak link in the big lifts, which will clearly lead to particular movement or power qualities an athlete may need. Good training unto itself is great ACL rehab, as long as it is pain-free. This includes eccentric tension focus and hamstring exercise focus (GHR, Reverse Hyper, etc).

Before we go any further, much of the theme of this post is inspired by one of the timeless Mike Boyle articles on StrengthCoach.com. His article was written in reference to a healthy athlete training to limit ACL tears. My suggestion is that when the time is right in terms of pain-free range of motion, rehab for the ACL-repaired athlete should look a lot closer to what Coach is describing than the tomfoolery of TKE and Wall Squats. Restoring pain-free range of motion minimizing arthogenic inhibition are the primary goals post-surgically, but for the surgical knee, anything you would do full-blast can be regressed properly, and there is another leg, a trunk, and 2 arms that can be challenged.
Primary focus of training of the injured athlete is to expose the body to as much appropriate stress as possible so when the body is physiologically healed, it is as close to neurologically prepared as possible. This is the principle.
Everything else is just your methods.

Thank you.

………you [have mentioned] deceleration being neuromuscular, and is not trained with slow eccentrics.

Slow eccentrics and isometric holds, as I mentioned above have a great place, but that slow strength, while by definition is deceleration, is not the same deceleration we see in full-speed performance. These movements can aid in the horsepower needed to overcome inertia to change directions, but it is not a guarantee that the it will be put to good use when practicing the terminal movements of your sport.
Slow strength is closer to General Physical Preparedness.
Narrowing the expressions of movement to be closer to the terminal expressions is Special Physical Preparedness.
And the specific movements themselves of the sport is Specific Physical Preparedness.
Evaluating where the individual is at all times along this overlapping spectrum is critical to determine where is the best place to train to improve deceleration, and which kind of deceleration. When I say above that deceleration is not trained with slow eccentrics, I am referring to more special and specific movements.

The deceleration that everything is geared for is stopping whatever you do and how quickly and correctly and efficiently you can execute the next athletic move. That type of open-loop performance is enhanced by slow strength but ultimately driven by great body balance and tone and random practice. It’s a dance to decide which you need more. I think you need both.
Strength is the fishbowl.
Strength does solve a lot of problems.
You still need to put it all together, and getting stronger isn’t always the best option.

When a Post-Op ACL athlete shifts away from the surgical knee in a deadlift, squat, land from a jump, etc., do I keep doing the movements? In most of my cases it is very subtle but I can still see some favoring toward the good leg.

I’d maybe keep them off jumping and force the weight shift with a banded RNT.
This is a movement or posture problem. Addressing it with a fitness solution is ill-advised. My suggestion is that by training for strength and power with jumps, pulls, and squats, you will condition the body for potentially positive physiological change at the expense of conditioning an undesirable neurological motor pattern, a baseline if you will.

He gets better getting faster and fitter, not stronger.

…..in single leg hops it looks like they just do not have much pop from the surgical side. Do I keep training it and [expect] it [to] catch up, or do I stick with more strength work?

If it looks right, and it is just weak, then maybe add 150% volume to that side. Maybe it’s down with the left, back with the right, down again with the left.
Other options are continued strength work, perhaps in this case 1-leg versions or 2-leg versions with a very mean RNT, and box jumps and drops.
As usual, the answer is probably D) All of the Above

It should be pretty hard to suck when you follow universal principles.